A New Sorrow for Afghanistan: AIDS Has Joined a Growing List

By CARLOTTA GALL

Published: March 19, 2007

Sitting and eating quietly on his father's lap, the 18-month-old was oblivious to the infection in his veins.

But his father, a burly farmer, knew only too well. It was the same one that killed his wife four months ago, leaving him alone with four children. The man started to cry.

''When my wife died, I thought, well, it is from God, but at least I have him,'' he said. ''Then I learned he is sick, too. I asked if there is medicine and the doctors said no. They said, 'Just trust in God.' ''

Cloistered by two decades of war and then the strict Islamic rule of the Taliban, Afghanistan was long shielded from the ravages of the AIDS pandemic. Not anymore.

H.I.V. and AIDS have quietly arrived in this land of a thousand calamities. They remain almost completely underground, shrouded in ignorance and stigma as the government struggles with the help of American and NATO forces to rebuild the country in the face of a new offensive by Taliban insurgents.

The father of this boy, the youngest Afghan known to have H.I.V., agreed to speak to a reporter only if their names and other details were omitted. He has not even told his family what his son has.

He said he believed that his wife contracted it through blood transfusions in Pakistan years ago.

The few surveys that exist suggest that Afghanistan has a low prevalence of H.I.V. -- only 69 recorded cases, and just three deaths. Yet health officials warn that the incidence is certainly much higher.

''That figure is absolutely unreliable, even dangerous,'' said Nilufar Egamberdi, a World Bank consultant on H.I.V./AIDS. The World Health Organization has estimated that 1,000 to 2,000 Afghans are infected, but Ms. Egamberdi said even that was ''not even close to reality.''

Dr. Saifur Rehman, director of the National AIDS Control program in the Ministry of Health, agreed. Afghanistan, a deeply religious and conservative country -- sex outside marriage is against the law -- may still be less at risk of the spread of the virus than other places.

But international and Afghan health experts warn that it faces the additional vulnerabilities of countries emerging from conflict -- lack of education and government services, mass movements of people and a sudden influx of aid money, commerce and outsiders.

Geography and migration make Afghanistan particularly susceptible. It is surrounded by countries with the fastest-growing incidence of AIDS in the world -- Russia, China and India. Other neighbors, Pakistan and Iran, have high levels of drug addiction and a growing number of H.I.V. infections, as does Central Asia to the north, experts say. AIDS can easily cross borders, carried by migrants or refugees who pick up drug habits or have sex with infected people in those countries and return home. Rates of drug addiction are rising in Afghanistan, with its booming opium and heroin trade.

Though the Afghan government and senior religious leaders have won praise for making H.I.V. a national priority, they are struggling with many problems.

''In Afghanistan, all the traditional risk factors for rapid spread of H.I.V. exist concurrently,'' said Dr. Fred Hartman of Management Sciences for Health, a Boston-based group working in Afghanistan. He has worked as technical director of Reach, an American-financed program to expand health care to Afghanistan's rural communities for three years, and has advised the government on H.I.V./AIDS.

Afghanistan experienced a trade boom in the last five years, and hundreds of thousands of Afghans go abroad, especially to Arab countries in search of work.

A European doctor, who asked not to be identified because his work was confidential, worked in a hospital in the United Arab Emirates where foreign workers went for mandatory testing and said that in 2001 and 2002, 23 Afghans were deported after testing H.I.V.-positive. ''There were only 30 known cases in Afghanistan then, and I knew of 23 more,'' he said.

The return home of more than two million refugees is another way the disease is likely to spread, said Renu Chahil-Graf, regional coordinator for Unaids, the United Nations program, who was visiting Pul-i-Charkhi prison in Kabul, where a voluntary testing clinic has opened. Some of those returning to Afghanistan have drug habits, and they spread AIDS by sexual contact with spouses, prostitutes and street children.

Afghanistan, the biggest opium- and heroin-producing country in the world, has nearly one million drug users, according to United Nations estimates. Most users still smoke the drug, but five years ago, injectable heroin hit the streets of Kabul, the capital. Now there are an estimated 19,000 intravenous drug users here, according to the World Bank. Addicts are not difficult to find, living in bombed-out buildings in the old part of the city and in Kota-e-Sangi, a neighborhood on the city's south side.

They are homeless or returned refugees, mostly young men, according to Miodrag Atanasijevic, a coordinator for Doctors of the World, a French aid group that runs a clean needles program in Kabul. ''It will become a huge thing,'' he said. ''In this country you have a lot of drugs.''